Provider Demographics
NPI:1245498096
Name:BRAVARD, REBECCA SUZANNE (DC)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:SUZANNE
Last Name:BRAVARD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 E 13TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-4435
Mailing Address - Country:US
Mailing Address - Phone:563-508-5870
Mailing Address - Fax:
Practice Address - Street 1:323 E 13TH ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-4435
Practice Address - Country:US
Practice Address - Phone:563-508-5870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011152111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor